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Post by benyiju on Jun 1, 2015 8:35:18 GMT -5
From diabetesdaily.com: afrezza insurance denial
I have been a Type 1 for 42 yrs. I was on the clinical trial for Afrezza in 2007-09. It worked wonderfully for the 2 yrs on was on it. Waited all these years for FDA approval. Thankfully when it came and Afrezza was available my Dr had me come in for the spirometry and wrote the Rx. Had it filled at my local pharmacy no problem. Insurance (Caremark) covered its part and I had the copay card which gave me the first 30 day supply free. My first refill no problem. My second refill called in last week I went to pick up and was told approval was denied. Need prior authorization. The third fill mind you and now they wanted authorization ? My Dr's office called them and faxed over the paperwork need to show dr authorization. They still have denied it. The dr office just told me it was denied because I am physically capable of taking an injection. Seriously ? How can they do this ? I am obviously going to appeal this but am extremely upset that they filled the first 2 with no problem and then without any notification they suddenly need prior auth. I was doing so well on the Afrezza. Less low blood sugars and better control. I guess that doesn't matter. If the ins co keep doing this I fear Afrezza will not fair well. I know i can't pay the full cost. Something has to be done to halt these companies from doing this. By doing this and not giving me a prior heads up it left me with almost no insulin and this was on a Friday. www.diabetesdaily.com/forum/introduce-yourself/84106-
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Post by ezrasfund on Jun 1, 2015 8:53:26 GMT -5
Can someone recommend the Sanofi "concierge service" to this person. Maybe they can help.
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Post by Deleted on Jun 1, 2015 9:00:25 GMT -5
I Have Caremark and it's covered. Is this obamacare or something
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Post by liane on Jun 1, 2015 9:03:35 GMT -5
The link ben provided is no longer working. Hmmm...
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Post by harryx1 on Jun 1, 2015 9:05:09 GMT -5
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Post by Deleted on Jun 1, 2015 9:35:31 GMT -5
Maybe this gets back to the fda label issue not recognizing afrezza as a superior treatment. As a result the insurance industry will balk at paying a premium price and push people towards the cheaper but "just as effective" option. Mind you, I understand the difference but the insurance industry will go with whats provided by fda. I'm making assumptions here I cant prove.....accurate post? Is it truly more expensive? And really no idea whats going on inside the insurance industry.........but I do wish sny priced afrezza agressively to get passed the gate keepers.
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Post by Deleted on Jun 1, 2015 9:46:39 GMT -5
In the end you'll be glad it's priced here.
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Post by s4cure on Jun 1, 2015 10:10:45 GMT -5
In the end you'll be glad it's priced here. Fug, What's your basis of saying so?
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Post by Deleted on Jun 1, 2015 11:24:05 GMT -5
In the end you'll be glad it's priced here. Fug, What's your basis of saying so? If company X sells 1 million widgets, would you rather they sell for $1 each or $1.50? Yes I know the retort, how many customers do you lose by selling $1.50. However most of us here believe that it's paradigm shifting and we should expect/demand a premium based on that belief. Selling low so that sales out of the gate can be X instead of Y, until insurance catches up, is a short term concern that I don't lose much sleep over.
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Post by mnkdorbust on Jun 1, 2015 11:43:35 GMT -5
I would go as far to say also that the samples equalize the price for those who have pricing concerns. I care less about price (within reason) for a product (whatever it be) if i'm able to try it out than make a decision rather than just taking a leap of faith. With the majority of the users saying things like life changing, etc cost isn't as much of an issue when it provides you a better quality of life.
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Post by esstan2001 on Jun 1, 2015 11:57:46 GMT -5
Fug, What's your basis of saying so? If company X sells 1 million widgets, would you rather they sell for $1 each or $1.50? Yes I know the retort, how many customers do you lose by selling $1.50. However most of us here believe that it's paradigm shifting and we should expect/demand a premium based on that belief. Selling low so that sales out of the gate can be X instead of Y, until insurance catches up, is a short term concern that I don't lose much sleep over. In addition, at some point insurance companies will prefer Afrezza due to it's superior patient outcomes... less weight, less hypos, less nerve damage, etc. This will support a premium price. It is just a question of when...
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Post by gestan on Jun 1, 2015 12:17:12 GMT -5
Take it one step further and insurance companies will require Afrezza over needles to reduce hypoglycemic reaction risk. Hypoglycemic reaction is big trouble. The big danger is because it introduced risk of death. If a care giver makes a error and accidentally applies too much insulin, things are at greater risk in traditional treatment paradigms as apposed to those using Afrezza based treatment.
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Post by mnholdem on Jun 1, 2015 12:26:07 GMT -5
Interesting thread. Perhaps I may contribute by pointing out something Cheepak wrote in his analysis published recently on behalf of Jeffries. Cheepak issued a "Buy" rating at $9 1-Yr Target & $37/share target by 2017.
More importantly, he noted that by August 2015, the initial 6-month "new drug" period will have elapse and that he fully expects that 3rd party payers will move Afrezza to a preferred / Tier 2 rating.
Anyone who thinks that Sanofi is sitting on their hands...well, my guess then would be that you don't know Sanofi very well. Sanofi will make certain (and FDA cannot prevent) that the anecdotal evidence being provided by Afrezza's early adopters is being brought to the insurance carriers attention...
Besides. It's typically much better to start with a premium and offer a discount, than the other way around. Once the insurance carrier sticks you with a lower price as "standard" that's all they'll pay.
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Post by Deleted on Jun 1, 2015 14:41:46 GMT -5
Interesting thread. Perhaps I may contribute by pointing out something Cheepak wrote in his analysis published recently on behalf of Jeffries. Cheepak issued a "Buy" rating at $9 1-Yr Target & $37/share target by 2017. More importantly, he noted that by August 2015, the initial 6-month "new drug" period will have elapse and that he fully expects that 3rd party payers will move Afrezza to a preferred / Tier 2 rating. Anyone who thinks that Sanofi is sitting on their hands...well, my guess then would be that you don't know Sanofi very well. Sanofi will make certain (and FDA cannot prevent) that the anecdotal evidence being provided by Afrezza's early adopters is being brought to the insurance carriers attention... Besides. It's typically much better to start with a premium and offer a discount, than the other way around. Once the insurance carrier sticks you with a lower price as "standard" that's all they'll pay. Maybe one of the reasons SNY is not doing all out sales & marketing blitz. They want to wait until it gets to Tier 2 in Aug so patients and doctors won't get frustrated and give up.
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Post by gamblerjag on Jun 1, 2015 18:53:42 GMT -5
How do you all interpret "by 2017"... by 1/1/17 or sometime in 2017... personally that means to me before 1/1/17.. just curious or maybe i'm being to literal.
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